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ObjectiveThe aim of this study was to better characterise clinical presentation, management and outcome in infants and children with brain abscess.MethodsThe authors conducted a retrospective, multicentre study in two national reference centres over a 25-year period (1992–2017). During this period, 116 children and 28 infants (age ResultsThe median age at diagnosis was 101.5 (range: 13–213) months in children and 1 (0–11) month in infants. Significant differences were observed between children and infants. The most common predisposing factor was meningitis in infants (64% of cases vs 3% in children), while it was otolaryngology-related infection in children (31% of cases vs 3.6% in infants). Infants presented more frequently with fever and meningism compared with children. 115 patients were treated with aspiration and 11 with excision. Reoperation was required in 29 children vs 1 infant. The overall mortality rate was 4% (3.4% for children, 7.1% for infants). At 3-month follow-up, the outcome was favourable in 86% of children vs in 68% of infants.ConclusionThere is a clear difference between children and infants with brain abscess in terms of predisposing factors, causative organisms and outcome. Despite surgical drainage and directed antibiotic therapy, 25% of patients with brain abscess require reoperation. Mortality is improved compared with historical series; however, long-term morbidity is significant particularly in the infant population.

Background and aims We retrospectively analysed cases of cerebral haemorrhage from arteriovenous malformation (AVM), admitted to a PICU of a tertiary hospital to determine management strategies and outcome. Methods Data were collected retrospectively from a departmental database between 2009 to 2014. Results 10 patients, all previously fit and well presented with spontaneous cerebral haemorrhage in the context of previously undiagnosed AVM. Median age at diagnosis was 12,5 years (8–15 years). (7 male, 3 female) All patients presented with headache and decrease in Glasgow coma scale. All patients had CT scan and angiogram as part of their initial evaluation and MRI for follow-up. Intracranial pressure monitoring devices were inserted in all patients and 5 required emergency craniotomy for haemorrhage evacuation. 6 required embolisation and 4 underwent gamma knife stereotactic radio surgery. 5 patients needed inotropic support with nor adrenaline during the first 24–36 h, 6 developed arterial hypertension during their PICU stay. Median length of stay in PICU 9,5 days (3–19 days). Median length of invasive ventilation 7 days (2–16 days), 1 patient received a tracheostomy after several failed extubation trials. Follow up after six months – one year showed seven patients with improving neurological signs, mostly hemiparesis, ataxia and diplopia. Two were asymptomatic and one patient has not reached the six month follow-up yet. Conclusions Treatment of cerebral haemorrhage in context of arteriovenous malformation includes a multidisciplinary approach with satisfactory results in neurological outcome on follow-up.